Don't stop me now........

Tomorrow, the date September 20th 2010 is an important milestone. It happens to be the start of my 50th year but that is not what I am referring to. (By the way that only makes me 49 so don’t expect me to be waving a cricket bat in the air yet).


Rather more importantly it is Week minus 10 in our countdown to opening the hospital. Soon we will need to be ready. At Week minus 3 on Thursday 11th November 2010 we aim to open to patients and in Week Zero on Thursday 2nd December we will have our Official Opening Ceremony. This not only sounds like a count down to launch of a space mission it feels like it too, and with weekly action plans and checklists we will try to avoid stopping the clock and launch on time. It is often said that the ‘Devil is in the detail’ but we have rather found that God has been there with us guiding and helping.



It is exciting to see things coming together; for instance we now have a pharmacy filled with a 2 month supply of generic drugs. Our only remaining really essential drug that we lack is Ketamine which will be our principal anaesthetic. We will have to arrange import of a years supply from Europeand as it is now a drug of abuse in the UK, this will be rather complicated and will require letters from the Ministry of Health.

Ruth, Rebecca and I had fun putting the tablets, syrups, creams and injectable drugs into alphabetical order on the shelves yesterday afternoon which will help with the occasional patients that we have to treat. If you think that sounds like exploitation of children don’t worry it was more like playing at shops and at least they had the benefit of an air conditioned room at 20C. It was a humid 37C brewing a thunderstorm outside.


The next couple of days will be busy as we enter the next phase of our recruitment process. On Tuesday we will have 200 qualified nursing and midwifery applicants to sit a written test at a school in N’djamena. We only need to recruit 10 nurses and 5 midwives so this is a difficult process. We hope as a result of the test to select about 30 candidates for practical tests and interview. You may wonder why doctors don’t figure on the list, this is because there is no medical unemployment and therefore none available. There are only 400 doctors in a country of 11 million people and the 20-30 who qualify each year are automatically in government service for their first 10 years. We will have to be patient and wait for the Ministry of Health to send us one.



Finally over the next couple of weeks we have overlapping visits by Steve Sanderson of BMS and Bert Oubre and other members of the CEF board. There will be plenty of meetings as there are strategic decisions on the relationship with the Health Ministry that need to be made and official documents that need drafting. Also we will discuss models for fees at the hospital; these need to be as low as possible whilst assuring long term financial viability. We will also meet with other followers of Jesus both Chadian and others to discuss how best to live out the Good News of the Kingdom of God in this context. Please think of Bert who in addition to having the responsibility of chairing our meetings will also try to bring a 39 litre ( 8 gallon) aluminium pressure cooker as part of his luggage. This is not a luxury destined to cook meals for the dignitaries and guest at the opening ceremony nor is it destined to cook food for the poor patients. It is rather an essential piece of low technology equipment that will be used on a gas burner to sterilise surgical equipment. It happens to be half the price in the US compared to the UK. I do hope they are kind to him at check in.

Two weeks is a very long time in mission

They say that you have to be polyvalent to practice medicine in Africa, but there are some things that you just can’t get training in. Mark is now trying his hand as a used car salesman, not an easy task at the best of times but the vehicle in question, an old Toyota that is surplus to our requirements, poses one or two extra problems. It has been parked for 3 years as it has a broken automatic gearbox which cannot be fixed or replaced and will need to be switched to a manual box by any purchaser . We wanted a picture of him in action, complete with large smile and firm reassuring handshake but sadly the guy who said he was interested if he could hear the motor run didn’t turn up today .
So what does this have to do with being a medical director? The answer is money. We are hoping for a good price as it’s not a cheap business setting up a hospital. We are now at the stage where we have sorted and counted all the equipment and supplies that have been sent as donations in the containers from the USA and know what essential equipment still needs procuring so that we can open in November. In addition we need a stock of drugs and a financial reserve to pay the salaries for the first few months. In the current economic climate any source of funds needs to be explored.

Chad, as you know, is a landlocked country so any importing drugs will be even more difficult than it was in Guinea. Therefore we will be trying to get our pharmacy supplies locally. There is a National Central Pharmacy Warehouse in Ndjamena and we have been encouraged by our first order which was for emergency room and operating theatre drugs. There were only 3 or 4 items not in stock but as they are the only suppliers for these in the country and they are essential for anaesthetics and childbirth we will have to hope that they have some for next month. If not we have to commence the difficult process of importing controlled drugs. For tablets although they do not have all the stock there is also a private Indian company who have a good supply of bulk generic medicines ( in boxes of a 1000) at a comparable price. Otherwise there is an expensive private wholesaler that sells medicines in individual patient boxes at a much higher unit cost that will be difficult for the poor to afford. This is worth praying about.

Despite the rain we are still managing to build as most of the work is internal alterations. With a bit of imagination the building which was first planned as a Lab and X ray block, and then built as an operating theatre with a very large recovery area is now being modified by the addition of a few walls and shelves and work surfaces to be a good operating theatre and maternity delivery ward . As many drugs should be stocked below 25C and nearly all below 40C we were pleased to find an air conditioning unit in a container and have installed it in a pharmacy stock room. The room also has shelves for our drugs made out of concrete to discourage termite attack. The laboratory now has work surfaces awaiting tiling.
In accordance with local practice an advert to recruit staff has been placed at the National Employment Agency and they have diffused this by radio and applications arrive daily. Soon we will begin selecting and training we’ll need wisdom and discernment as there is plenty of choice .
A visit to Meskine, Cameroon has provided a good insight into how to run a financially self sufficient hospital. CEF president, Bert Oubre, was one of the founders, hence the visit. It has many systems that we may want to use or adapt. We have already visited 2 local Chadian hospitals so ideas are coming together.

Whilst in Cameroon we had a great weekend walking in a land of extinct volcanoes and passing through a wildlife park with glimpses of warthogs and giraffes despite it being rainy season, Ruth and Rebecca have more on their blog.

That’s the second time we’ve mentioned rain and its still coming providing fun slipping on the wet clay to the main road. Apparently the rain was late again this year and then so heavy that the Sahel has both droughts and floods in different places. The consequences of further poor crops in villages that have little reserves can be catastrophic. We are sheltered from this in the capital and prices just alter a little but they do naturally with the seasons too. Please find time to look up and pray for those struggling with the climate in Chad and across the Sahel .

Le Manitou nouveau est arrive !

In our recent prayer letter we spoke of our plans to open the hospital in November. There are many things that need sorting out but one of our priorities is to sort through 5 shipping containers stood in the middle of our yard. They contain the accumulated building materials, medical equipment and supplies and personnel effects of previous missionaries over the past 5 years. Termites have been able to get in through the wooden floors as they were in contact with the ground and have eaten their way through quite a bit of stock so a solution needs to be found. We decided to empty the containers, clean them and then move them to a better site at the same time placing them on large lorry metal wheel rims to keep them well above soil level. Sounds easy enough but where do you find a crane or forklift big enough to lift a 40 foot shipping container? Ndilmbaye, fresh from his first annual leave in 3 years, found a local company about 4 KM away with such expertise and they agreed for a sum of 100000CFA per hour (£120) to come and do it.

Most of contents of the containers were removed to the wards and operating theatre in preparation and we were told that the forklift known here by the trade name Manitou would come on Friday 18th June. By 4 pm it was clear that they weren’t coming, the message was that they were too busy but would be sure to come Saturday morning, then Sunday morning and at last it arrived at Sunday lunchtime and promptly broke down in next to the containers. Despite the efforts of a couple of mechanics nothing could be done without a new fuel pump so they had to the market in town. It would have to be the next day .Unfortunately just before it arrived we had got out 3 heavy pieces of X-ray equipment and we couldn’t lift them back in even with the help of half a dozen young men from the village. We bought some large tarpaulins and covered the equipment as well as possible. Monday, the news was not good, no parts in Chad, it would have to be ordered from Cameroon, and they refunded our advance, and suggested we try to find someone else. Despite our prayers it rained but at least the tarpaulins did their job.

All very depressing if you are that way inclined, but happily for the moment we’re not.

A week later, I was beginning to wonder whether we would ever get a solution when out of the blue the original team came back and said they now had a replacement vehicle and they could come that evening if we would advance 2 hours work. Pleased but slightly sceptical we gave the money. Fifteen minutes later , LeManitou noveau est arrive! The driver was highly skilled and we were able to do the job with 15 minutes to spare. We also were able to lift all the heavy equipment back inside.

In the process we found as usual some wildlife, a desert hedgehog and a small monitor lizard, only 18 inches. It was caught and photographed and I was asked if the children wanted it. I said they could let it go, so they did and it ran under a pile of things next to the caretakers shack. Remind me next time to say let it go outside the wall. Suddenly one of the men decided he wanted to eat it, but the lizard was not to be found.

That same evening the spare part arrived and the repaired forklift was able to leave!

Now with the arrival of Clare, a nurse, our work at the hospital begins in earnest; the Arabic will have to take second place. The containers are cleaned and sprayed and planks on bricks are arranged for shelving. We are sorting through gloves, bandages and all manner of more complicated equipment and deciding which is still useful and in good condition. It will take the next few weeks. Meanwhile the builders and painters are finishing the rest of the hospital. I wonder what the next snag will be.

Rain at last.

We arrived 7 weeks ago to what looked like a desert, a few trees and scrubby bushes dotted around in plains of flat baked mud with no grass. There were some depressions which must have once held water. A surprising number of birds flew overhead, mainly Egrets a type of water bird heading to the River Chari that flows through the capital and north to Lake Chad. Cows and camels are driven past our home each day heading to get water. Nights are still and quiet apart from the braying of the donkey in the nearby village. The only wildlife around the house are the numerous lizards and occasional chameleons.

Things began to change, but not immediately for the better, the humidity rose, thunder rumbled in the towering clouds that came and went for more than a week. It was hot and sticky. The winds that fill the house with dust each day became stronger and we had to close all the windows despite the heat. Then driving Rebecca home one day the sky darkened with an enormous dust cloud that reduced visibility to about 50m, just as I was about to stop the car a few large drops and then heavy torrential rain. The windscreen wipers couldn’t cope and neither could the tyres as the sheets of baked mud became like a tropical ice skating rink. The car thermometer registered 39C as the rain began to fall, 20 minutes alter back at the house it had fallen to 26C. What a relief!

Realising what was to come we purchased a new set of windscreen wipers and 2 new front tyres with off road tread to replace 2 much worn tarmac tyres. We would have liked to buy 4, but having scoured the markets and garages that was all that was in stock. Next delivery estimated mid July. Our compound came to life with 3 species of butterfly including many beautiful swallow tails, crickets abounded and the first small green shoots appeared in the newly baked mud. Two weeks later we have had the second rain, even heavier and longer, deep wide puddle filled the space between the two houses. Next morning it had dried, but we woke to a chorus of frogs croaking at 6am. Roy told us to go and investigate before breakfast and we found that the depressions had become large ponds about 50m across and that they were full of hundreds no thousands of mating frogs. As there was no vegetation they were clearly visible and very noisy. Believe it or not they hibernate deep in the baked mud and wait for the rain. Dogo our driver arrived late as his car was stuck about 1km from our house.

Later at midday we took our 4x4 to tow him out, the frogs had disappeared but storks had arrived for their lunch. Slowly strutting around and plunging their long beaks into the muddy waters and down holes in the mud searching for frogs. They were stood amongst large flocks of egrets and graceful herons but are quite ugly bald headed and huge, standing 1.5m tall with a wingspan of 2.5m , and looking like a vulture as they circle on the thermals overhead . An absolutely amazing transformation ‘desert’ to wild life park, just add water.

Arcab- a Chadian ABC

Arcab -is a very useful Arabic word that despite its nautical connotations is very useful in landlocked Chad. It means ‘get on board’ and can be used for all types of transport.
Boats- the pirogues, dug out canoes, that criss cross the river on the way to Cameroon ferrying people, motorbikes and the odd goat.- Arcab?
Camels- this one was grazing on the land outside the hospital yesterday. They are here for the dry season, but will all leave before the rains. Today we saw two men, heads and faces swathed with cloth against the dust, heading north to the desert. Each was riding one camel and leading another laden with sacks of millet.Arcab?
Donkeys- these seem to like it here and look very healthy, reminds us of the beach at Skegness when the tide has gone out. One lives nearby and brays all the time. I had rather expected to be awoken by the call to prayer from the mosque,no doubt that will come. For the moment it is the cockerel and the especially the donkey. Arcab?
Everything else on the road. Yellow taxi, minibus, UN landcruiser , or motorbike. But not either ‘Klando’ that is motorbike taxi or ‘Racksha’, motorcycle rickshaw. These have been banned in N’djamena by Presidential decree, to ease the congestion on the roads. ( so that’s 2 words of Arabic that we shouldn’t have bothered learning) Despite that motorbikes, presumably not for hire, are still plentiful and pass on the inside all the time which is especially hazardous at roundabouts. Often there are two people, often a 3rd, a child strapped on the mothers back, sometimes a horned sheep! Arcab?
Enjoy your ride,
Love Mark and Andrea

Chad is hot- Official

You would expect us to think that it is hot, our last entry didn’t say much else! Now the Chadians are all saying it is hot, ‘haami’ , one of the few words we’ve picked up in local Arabic. It is so hot that more children than usual are falling ill and the Ministry of Education has decreed that Primary schools should finish at 11:00 rather than the usual 12:30
We got our Chadian driving licenses this week, they took 2 weeks and 4 visits to the office by N’dilmbaye our administrator, rather than the 2 days that it is supposed to take. Interestingly they are both stamped 28/04/2010, just 2 days after we applied. Does this mean that they were really ready all that time? Or do they post date things to make it look efficient?
We are now eating Chadian food, as Rebecca , a widow from the local church, is now cooking for us. The food is delicious and we can benefit from all the food at the markets, maize flour boule, rice, and locally grown veg.
This week saw our first Chadian Arabic lessons. It is one of the 2 official languages and is much more widely spoken than French. Local officials can often only speak greetings in French so mastering Arabic is essential. Three mornings a week we have a three hour lesson at a development centre. Our teacher, Aboukar, has a masters degree in linguistics from a French University and can really teach well. So now it is up to us to do the hard hours of homework each day.
Bye for now, stay cool,
Mark and Andrea

Living in the heat of the day

You know that it is hot when you take the plates out of the cupboard in the shady kitchen and they feel warm, not hot but definitely warm. By day it is about 42C outside in the shade, I know its cheating but it measures 54C in direct sunlight! Inside it is about 37C. By night the outside temperature eventually falls at about 4am to 28C inside it stays at a warm 32C. Humidity is low, a slice of fresh pineapple looked remarkably like it had been bought dried after 24 hours and the ground drinks up the water put on the recently planted citrus trees. One plus yoghurt is really easy to make just take water at ambient temperature, milk powder and a spoonful of live yoghurt and leave for 6 hours on the side!
So how would you like to go to school in all this heat. Ruth and Rebecca start tomorrow at 09:00 and though they will have an air conditioned classroom it will be hot as they try to do a general test in French on their language and mathematics ability. The results will determine which year group they will be assigned to. This is the hardest bit for them , so please pray for them as they adjust to school that starts at 07:30 each day and is entirely in French.